title: Pure bipolar plasma vaporization of the prostate: the Zürich experience.
abstract: OBJECTIVE
  Bipolar plasma vaporization (BPV) has been introduced as an alternative to transurethral resection of the prostate (TURP). Promising short-term results, but inferior mid-term results compared to TURP have been reported following first-generation bipolar electrovaporization. Outcome data following second-generation BPV are still scarce. The aim of this investigation was to evaluate the intra- and postoperative outcomes of contemporary BPV in a center with long-standing expertise on laser vaporization of the prostate.
  
  
  METHODS
  A consecutive series of 83 patients undergoing BPV in a tertiary referral center was prospectively evaluated. The investigated outcome parameters included the maximum flow rate (Qmax), postvoid residual volume, International Prostate Symptom Score (IPSS)/quality of life (Qol), and prostate-specific antigen (PSA) tests. Follow-up investigations took place after 6 weeks, 6 months, and 12 months. The Wilcoxon signed-rank test was used to compare pre- and post-treatment parameters.
  
  
  RESULTS
  The median (range) preoperative prostate volume was 41 mL (17-111 mL). The preoperative IPSS, Qol, Qmax, and residual volume were 16 (2-35), 4 (0-6), 10.1 mL/s (3-29.3 mL/s), and 87 mL (0-1000 mL), respectively. One third of the patients were undergoing platelet aggregation inhibition (PAI). No intraoperative complications occurred. Postoperatively, 13 patients (15.7%) had to be recatheterized. Three patients (3.6%) had clot retention and 28 patients (34%) reported any grade of dysuria. After 6 weeks, all outcome parameters improved significantly and remained improved over the 12-month observation period [IPSS: 3 (0-2); Qol: 1 (0-4); Qmax: 17.2 mL/s (3.2-56 mL/s); residual volume 11 mL (0-190 mL)]. The PSA reduction was 60% at study conclusion. Three patients (3.6%) developed a urethral stricture and four patients (4.8%) bladder neck sclerosis. Re-resections were not necessary.
  
  
  CONCLUSIONS
  Contemporary BPV is a safe and efficacious treatment option even for patients undergoing PAI. Early urinary retention and temporary dysuria seem to be specific side effects of the treatment. Bleeding complications are rare. Long-term follow-up is needed to confirm these promising short-term results.
authors.affiliation: Department of Urology, University Hospital Zürich , Zürich, Switzerland .
authors.forename: Benedikt
authors.initials: B
authors.lastname: Kranzbühler
authors.forename: Marian Severin
authors.initials: MS
authors.lastname: Wettstein
authors.forename: Christian D
authors.initials: CD
authors.lastname: Fankhauser
authors.forename: Nico C
authors.initials: NC
authors.lastname: Grossmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Gross
authors.forename: Cédric
authors.initials: C
authors.lastname: Poyet
authors.forename: Remo
authors.initials: R
authors.lastname: Largo
authors.forename: Boris
authors.initials: B
authors.lastname: Fischer
authors.forename: Matthias
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.forename: Alexander
authors.initials: A
authors.lastname: Müller
authors.forename: Thomas
authors.initials: T
authors.lastname: Hermanns
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011469:Prostatic Diseases / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome